A patient with fractures of the 3rd and 4th cervical vertebrae, and with ventilatory failure, was managed with cervical traction, tracheostomy, and mechanical ventilation. The patient had a lower motor neuron lesion of the right phrenic nerve. A phrenic nerve stimulator was implanted on the left, permitting ventilatory manage- ment with phrenic nerve pacing during the day and mechanical ventilation at night. Five months after the initial injury, discoordinate and inconsistent spontaneous diaphragmatic activity was noted. A regimen of muscle re-education and strength- ening of the left hemidiaphragm was initiated, using myoelectric and volume-linked audiovisual feedback. Within 26 sessions the patient was able to ventilate spon- taneously for 12 hours, permitting discontinuance of mechanical ventilation and making it possible to transfer him to a rehabilitation facility.
Sadowsky et al. (Sun,) studied this question.